Pain location after ureteroscopy differs based on sex and stone location: results from STENTS

Abstract

Objectives: To expand understanding of the patient experience after ureteroscopy with stent placement for ureteric and/or renal stones using a body map to identify pain location and site-specific pain intensity over time, while evaluating the associations of sex and stone location.

Patients and methods: Participants in a multicentre prospective observational cohort study completed questionnaires at baseline and on postoperative days (PODs) 1, 3 and 5. Pain distribution and intensity were assessed using the Brief Pain Inventory body and genitalia maps, with results stratified by sex and stone location.

Results: A total of 424 participants (47% female, mean age 49 years) at four centres were included. The most frequent sites of stent-associated pain were the back, followed by the abdomen and pubic regions. Male participants were more likely to report the ipsilateral back as the site with most intense pain on POD 1 (43% vs 19%; P < 0.01) and POD 3 (43% vs 24%; P < 0.01), independent of stone location; they also reported more burning during urination on all PODs (P < 0.01). Female participants more often reported pain in the abdomen on POD 1 (67% vs 50%; P = 0.01) and in the pubic region on POD 3 (56% vs 37%; P < 0.01). Genital pain was common and peaked on POD 1 in both sexes. Participants with a renal stone were more likely to report back pain (70% vs 53%; P = 0.009) and a higher pain intensity score in the back (P = 0.014) on POD 1. Participants with ureteric stones were more likely to have baseline abdominal pain, most intense pain in the pubic region (27% vs 14%; P = 0.017), and burning during urination on POD 1 (P < 0.001).

Conclusions: Body pain map analysis provides new insights into patient experiences after ureteroscopy, with significant differences in pain location and intensity based on sex and stone location. These results can inform patient-specific counselling in the preoperative setting, contribute to a better understanding of the patient experience, and help tailor management decisions.

Keywords: kidney stones; pain intensity; patient experience; ureteric stent; ureteroscopy.